Parental mental health and parenting: How are they related?

Prevalence of parental mental illness

Estimates of the prevalence of parental mental illness vary, but Australian research has found that up to one in four children are being raised by a parent with mental illness (Maybery et al., 2019). International research has found that up to 36% of patients seeking psychiatric treatment are parents caring for dependent children (Ruud et al., 2019).

The above findings are consistent with recent research by the Parenting Research Centre (PRC). Speaking to parents of children aged 0-18 years, the Parenting Today in Victoria study found that parental mental health issues were common amongst the 2,600 participants (Millward, Matthews, Wade, Forbes & Seward, 2018; Wade, et al., 2018). While most parents reported good mental health, more than a quarter were currently experiencing moderate (24%) to serious (4%) psychological distress. In addition, 28% of parents had experienced depressive symptoms and 28% had experienced anxiety symptoms since having children.

The impact of parental mental health on children

Recent analyses using data from the Longitudinal Study of Australian Children showed that parental mental health early in a child’s life was related to children’s long-term mental health outcomes (Rioseco, Warren & Daraganova, in press). Children whose parents had experienced moderate or high levels of psychological distress were more likely to experience social-emotional difficulties over time.

The relationship between parent and child mental health difficulties has a number of possible explanations. Some research has hinted at a genetic link – for example, twin and adoption studies have suggested a role of heredity in some mental health conditions, including schizophrenia, bipolar disorder, and major depression (Craddock & Sklar, 2013; Hilker et al., 2018; McGuffin et al., 2003).

However, in most cases it is likely that genetic factors interact with environmental factors (e.g. trauma exposure, the availability of supportive people, and parenting quality) to impact on a child’s mental health. Environmental factors can be risk or protective factors for child mental illness and many are modifiable, especially those related to parent-child interactions.

Effects of parental mental health on parenting

A parent’s mental health can influence the quality of their interactions with their child (Reupert, Maybery & Kowalenko, 2013). In research conducted by the PRC (Millward et al., 2018), parents with poorer mental health were more likely to use harsher discipline (e.g. smacking, yelling) compared to those with better mental health. These parents were also less equipped to use positive parenting strategies (e.g. rewards for good behaviour, talking to children about problems).

16% of parents with poor mental health reported arguing or yelling quite a lot or very much with their children, compared to 8% of parents with better mental health.

Parents with poorer mental health also reported higher rates of wishing that they did not become impatient so quickly with their children (51% as opposed to 37%). A greater proportion of parents with worse mental health also wished they were more consistent in their parenting and felt they were too critical in child-parent interactions.

Parents with mental health difficulties also reported spending less time playing games or exercising with their children.

The above findings are supported by other Australian and international studies (Bronte-Tinkew, Moore, Matthews & Carrano, 2007; Giallo et al., 2015; Giallo, Cooklin, Wade, D’Esposito & Nicholson, 2014a; Giallo, Cooklin, Wade, D’Esposito & Nicholson, 2014b; Giallo, Treyvaud, Cooklin & Wade, 2013; Pape & Collins, 2011; Oyserman, Bybee, Mowbray & Hart-Johnson, 2005).

Parental mental illness is not always associated with negative outcomes for children.

Despite the above findings, it is important to highlight that parents’ mental health concerns do not always predict poorer child outcomes. Even during times of acute distress, parents with mental illness can parent well, and the impact on their children can be minimised with the right combination of family and social support to keep children emotionally well (Reupert, Maybery & Kowalenko, 2013).

Implications

For parents who may be struggling with parenting, regardless of their mental health status, help is available. Parenting is a learned set of skills that can be acquired and improved, and there is always a role for practitioners and services to assist parents with strengthening their parenting.

Programs focused on building parenting skills and coping have been shown to be effective, even for parents experiencing sub-optimal mental health (Barlow, Coren & Stewart-Brown, 2002; Maybery et al., 2019). Strategies for supporting parents with mental health challenges will be explored in a forthcoming short article by the author.

In Australia, Let’s Talk About Children is offered through The National Workforce Centre for Child Mental Health as a resource for professionals to build expertise in structured discussions about parenting with parents experiencing mental health problems. Let’s Talk helps routinise the conversation about parenting and mental illness, allowing an exploration of how a parent’s mental health difficulties might impact on their children.

Conclusions

Poorer outcomes for children, including child mental health problems, are not inevitable in cases where parents have mental illness. Children thrive when their parents are supported to provide a safe and nurturing environment, even in the face of challenges like parental mental illness.

Practitioners can improve outcomes for children by offering support and parenting skills training to parents who have mental health problems. Child development and wellbeing are optimised when parents feel confident about parenting.

References

Barlow, J., Coren, E., & Stewart-Brown, S. (2002). Meta-analysis of the effectiveness of parenting programmes in improving maternal psychosocial health. British Journal of General Practice, 52(476), 223-233.

Bronte-Tinkew, J., Moore, K.A., Matthews, G., & Carrano, J. (2007). Symptoms of major depression in a sample of fathers of infants. Journal of Family Issues, 28, 61-99.

Craddock, N., & Sklar, P. (2013). Genetics of bipolar disorder. The Lancet, 381(9878), 1654-1662.

Giallo, R., Cooklin, A., Brown, S. Christensen, D., Kingston, D., Liu, C., Wade, C., & Nicholson, J. (2015). Trajectories of fathers’ psychological distress across the early parenting period: Implications for parenting. Journal of Family Psychology, 29, 766-76.

Giallo, R., Cooklin, A., Wade, C., D’Esposito, F., & Nicholson, J. M. (2014a). Fathers’ postnatal mental health and child well-being at age five: The mediating role of parenting behavior. Journal of Family Issues, 35(11), 1543-1562.

Giallo, R., Cooklin, A., Wade, C., D’Esposito, F., & Nicholson, J.M. (2014b). Maternal postnatal mental health and later emotional-behavioural development of children: The mediating role of parenting. Child: Care, Health & Development, 40(3), 327-36.

Giallo, R., Treyvaud, K., Cooklin, A., & Wade, C. (2013). Mothers’ and fathers’ involvement in home activities with their children: Psychosocial factors and the role of parental self-efficacy. Early Child Development and Care, 183(3-4), 343-359.

Hilker, R., Helenius, D., Fagerlund, B., Skytthe, A., Christensen, K., Werge, T.M. … Glenthøj, B. (2018). Heritability of Schizophrenia and Schizophrenia Spectrum Based on the Nationwide Danish Twin Register. Biological Psychiatry, 83(6), 492-498.

Maybery, D., Goodyear, M., Reupert, A., Sheen, J., Cann, W., O’Hanlon, B., & Cuff, R. (2019). A mixed method evaluation of an intervention for parents with mental illness. Clinical Child Psychology and Psychiatry, 24(4), 717-727.

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Pape, S.E. & Collins, M.P. (2011). P01-170 – A systematic literature review of parenting behaviours exhibited by anxious people. European Psychiatry, 26, 170.

McGuffin, P., Rijsdijk, F., Andrew, M., Sham, P., Katz, R., & Cardno, A. (2003). The heritability of bipolar affective disorder and the genetic relationship to unipolar depression. Archives of General Psychiatry, 60(5), 497–502.

Millward, C., Matthews, J., Wade, C., Forbes, F., & Seward, A. (2018). Parent Mental Health (Research Brief). Melbourne, Australia: Parenting Research Centre. Retrieved from: https://www.parentingrc.org.au/wp-content/uploads/Mental-Health-Research-Brief-Oct-2018.pdf

Oyserman, D., Bybee, D., Mowbray, C., & Hart-Johnson, T. (2005). When mothers have serious mental health problems: Parenting as a proximal mediator. Journal of Adolescence, 28, 443-463.

Reupert, A.E., Maybery, D.J., & Kowalenko, N.M. (2013). Children whose parents have a mental illness: Prevalence, need and treatment. The Medical Journal of Australia, 199(3), 7–9.

Rioseco, P., Warren, D., & Daraganova, G. (in press). Trajectories of children’s social-emotional wellbeing in the Longitudinal Study of Australian Children: The role of parenting, parents’ mental health and health behaviours. Paper produced for Emerging Minds. Australian Institute of Family Studies.

Ruud, T., Maybery, D., Reupert, A., Weimand, B., Foster, K., Grant, A., et al. (2019). Adult mental health outpatients who have minor children: Prevalence of parents, referrals of their children, and patient characteristics. Frontiers in Psychiatry, 10, 163.

Wade, C., Matthews, J., Bent, C., Neill, E., Petrovic, Z., Fisher, J., Michaux, A., Cann, W. (2018). Parenting Today: A state-wide representative survey of contemporary parenting experiences. Children Australia, 43(1), 77-85.